Coronary artery disease
Cardiac Arrest in Patients Who Smoke Crack Cocaine

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The aim of the study is to determine the clinical features and outcomes of cocaine users admitted to the hospital after cardiac arrest and compare them with nonusers. Cocaine is associated with cardiovascular complications, including ventricular arrhythmias; however, resuscitated cardiac arrest in relation to cocaine use is not a well-defined clinical entity. We reviewed available hospital charts at San Francisco General Hospital with the International Classification of Diseases, Ninth Revision diagnosis of cardiac arrest and cocaine use from 1994 to 2006. Clinical features and outcomes of cocaine users were compared with those of randomly selected control patients and age-matched controls with resuscitated cardiac arrest without cocaine use. We identified 22 patients with resuscitated cardiac arrest in the setting of cocaine use. Their average age was 42 ± 10 years, >20 years younger than nonusers (68 ± 16 years, p <0.01). After cardiac arrest, 12 of 22 patients (55%) who used cocaine had complete neurologic recovery in contrast to only 3 of 20 unmatched controls (15%, p <0.01) and 7 of 41 age-matched controls (17%, p <0.01). Only 10 of 22 cocaine users (46%) died compared with 15 of 20 unmatched controls (75%, p = 0.05) and 32 of 41 age-matched controls (78%, p <0.01). In a combined analysis of all patients, cocaine use was the only significant predictor of neurologic recovery (p <0.01) and survival (p <0.01). In conclusion, cocaine use is associated with cardiac arrest. In patients with cardiac arrest, cocaine users are younger than nonusers and more likely to survive with neurologic recovery, even compared with age-matched controls with cardiac arrest.

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Methods and Results

We searched the medical record database of San Francisco General Hospital from 1994 to 2006 to identify all patients who were resuscitated after sudden cardiac death (cardiac arrest) who had used cocaine within 24 hours before the cardiac arrest. Patients with electrocardiographic evidence of ST-segment elevation myocardial infarction were excluded. We selected the first available patients with cardiac arrest and no cocaine use as a control group. Because of the large difference in age between

Discussion

In this study, we found that cocaine users resuscitated from sudden cardiac death were much younger than nonusers with cardiac arrest and less likely to have a history of coronary disease, heart failure, or atrial fibrillation. More than half the cocaine users survived with complete neurologic recovery. Conversely, survival with neurologic recovery was very uncommon in control patients resuscitated after cardiac arrest, even in an age-matched control group. We speculate that cocaine users have

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Dr. Hsue is a recipient of a Clinical Scientist Development Award from the Doris Duke Charitable Foundation, New York, New York.

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